Fatima Noor, 42, has been working on polio eradication for two decades. She says immunization drives have become terrifying since the Taliban started attacking vaccinators.

Jason Beaubien
/ NPR

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Originally published on August 25, 2014 12:00 pm

When my translator and I arrive in a crowded, dusty neighborhood in Karachi, Fatima Noor is waiting in a full black burqa. But she pretends not to see us.

She turns down the alley and disappears. We follow her into a neighborhood, where the buildings are so close together that Noor's burqa brushes the walls.

Finally she slips into the entryway of a building, and with a sigh of relief, she pulls back her headscarf.

Noor is a 42-year-old mother of three. She's also one of Pakistan's roughly 100,000 Lady Health Workers, who help provide basic health services to children in slums and remote rural areas of Pakistan.

On this day, she and two other workers are immunizing kids for measles. The trio is explaining to a group of young mothers how their children will need to get measles booster shots in a year and a half.

Being a front-line health worker usually isn't controversial. But in Pakistan, it can get you killed.

The Taliban went on an offensive against polio immunization in 2012 after it became clear that the CIA used a fake hepatitis vaccination campaign to gather intelligence on Osama bin Laden.

"Whenever I go out for a polio campaign, my heart is scared, and my mind is not working," Noor says through our translator.

During polio drives, she goes door to door giving children drops that protect them from permanent paralysis.

But the attacks have completely changed the drives, Noor says. She no longer wants to be seen carrying the small, blue ice chest that holds the vaccine.

"We ask one of the kids to go in the street and check if the situation is all right or not," Noor says. "And I'll get my son to carry the vaccine cooler. He hides it inside a shopping bag. And I'll be covered in a burqa."

Noor has worked as a Lady Health Worker for 20 years and earns roughly $70 a month. During nationwide polio immunization drives, many of the other vaccinators are hired by the day. They earn just $2.50 a day, which is so low that even in Pakistan, they're often referred to as "volunteers."

Her team has never been attacked, she says. But whenever they hear something that sounds like gunfire, they all run and hide. And when the vaccinators go into an apartment building, they post one person to wait outside and watch for trouble.

"When we come out of a building, we have to be careful," Noor says. "Sometimes we stop for a while to see if anyone was watching us."

Sometimes they also travel with a police escort.

In most neighborhoods, she says, parents accept the vaccine. But in some places — usually poor slums — parents can be hostile. Some refuse to have their children vaccinated, saying the campaign is a Western plot against Muslims or a government scheme to sterilize their children.

"People are saying that it's a form of family planning," she says. "We tell them that if the government wanted to, they could add birth control into anything, into the water, into the food."

Eventually, many parents accept that the rumors don't make sense.

What's harder to overcome in Pakistan is the fear created by the militant attacks on polio workers. Whenever another vaccinator gets shot, Noor's husband urges her to stop going on campaigns and to stay home.

But Noor says she can't. To her, protecting Pakistani kids from polio paralysis is crucial to the country — especially since there's no treatment for the disease.

"These are our children, and it's obvious we will not let them be disabled," she says.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

ARUN RATH, HOST:

As polio is pushed to the brink of extinction, Pakistan is the only place in the world where the number of people with the disease is expanding significantly. There have been more than 100 cases in the country so far this year. Pakistan is also the only place in the world where polio vaccinators' lives are constantly at risk. NPR's Jason Beaubien recently traveled to the country's largest city, Karachi, and he has this profile of one polio vaccinator and the challenges she faces.

JASON BEAUBIEN, BYLINE: I've arranged to meet Fatima Noor in a crowded, dusty neighborhood in Karachi. When I arrive with my translator, Fatima is waiting in a full, black burqa. But she pretends not to see us. Fatima turns and disappears down an alley. We jump out of the car and follow her.

(CAR DOOR SHUTTING)

BEAUBIEN: This is a neighborhood of crudely constructed five and six-story concrete apartment blocks. Laundry and electrical wires flap from the balconies. The buildings are so close together that Fatima's burqa brushes the walls of the narrow passage. Finally, she slips into the entryway of a building. And with a sigh of relief, she pulls back her headscarf.

UNIDENTIFIED MAN: Leave our shoes here or...

FATIMA NOOR: (Speaking in foreign language).

BEAUBIEN: Fatima is a 42-year-old mother of three. She's one of Pakistan's roughly 100,000 lady health workers. They help provide basic health services in slums and remote, rural areas. On this day, Fatima and two other workers are immunizing kids for measles.

UNIDENTIFIED WOMAN: (Speaking foreign language).

BEAUBIEN: The trio is explaining to a group of young mothers how their children will need to get measles booster shots in a year and a half. Being a front-line health worker usually isn't controversial. But in Pakistan, ever since the Taliban declared a ban on polio vaccination, it can get you killed. The Taliban went on an offensive against polio immunization two years ago. It was in response to the CIA using a fake hepatitis vaccination campaign in Pakistan to gather intelligence on Osama bin Laden.

(BIRDS CHIRPING)

BEAUBIEN: During polio drives, Fatima goes door-to-door giving children drops that protect them from a horrific and permanent paralysis.

NOOR: (Through translator) Whenever I go out for a polio campaign, my heart is scared and my mind is not working.

BEAUBIEN: It's scary because more than 60 polio workers have been gunned down since the Pakistani Taliban declared the polio vaccination ban in 2012. Fatima says the attacks have completely changed the polio immunization drives. She no longer wants to be seen carrying the small, blue ice chest that holds the vaccine.

NOOR: (Through translator) We ask one of the kids to go in the street and check if the situation is all right or not. And I will get my son to carry the vaccine cooler. He hides it inside a shopping bag, and I will be covered in a burqa.

BEAUBIEN: Fatima has worked as a lady health worker for 20 years and earns roughly 70 U.S. dollars a month. During the nationwide polio immunization drives, many of the other vaccinators are hired by the day. They earn just two and a half dollars a day, which is so low that even in Pakistan they're often referred to as volunteers. Fatima says her team has never been attacked. But whenever they hear something that sounds like gunfire, they all run and hide. When the vaccinators go out into an apartment building, they post one person to wait outside and watch for trouble.

NOOR: (Through translator) When we come out of a building, we have to be careful. Sometimes we stop for a while to see if anyone was watching us.

BEAUBIEN: Sometimes they also travel now with a police escort. She says in most neighborhoods, parents accept the vaccine. But in some places, usually poor slums, they're hostile. She says some parents refuse to have their children vaccinated, saying the campaign is a Western plot against Muslims or a government scheme to sterilize their children.

NOOR: (Through translator) People are saying that it's a form of family planning. The lady health workers have to argue with them. We tell them that if the government wanted to, they could add birth control into anything - into the water, into the food.

BEAUBIEN: Eventually, she says, the parents accept that the rumors don't make sense. What's harder to overcome in Pakistan, however, is the fear created by the militant attacks on polio workers. Whenever another vaccinator gets shot, Fatima's husband urges her to stop going out on the campaigns, to just stay home. But Fatima says she can't stay home because to her, protecting Pakistani kids from polio paralysis is crucial to the country.

NOOR: (Through translator) Almost every disease has treatment. There is no treatment for polio. These are our children, and it's obvious, we will not let them be disabled.

BEAUBIEN: And that's what keeps her going out the door on the polio vaccination drives. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.